Fecal Incontinence

Fecal Incontinence – 1 in 5 Women Suffer Silently

By:  Dr. Linda Kiley, MD

 They think it’s embarrassing.  They don’t tell their friends.  They don’t tell their family members.  And, worst of all, they don’t tell their doctors.  As many as twenty percent (20%) of women experience fecal incontinence during their lifetimes.  These are staggering numbers!  There is no reason to hide in the closet feeling alone and helpless.  It is not shameful.  It is not unusual.  And there IS something they can do about it.

 There are several types of fecal or anal incontinence, some of which are not terribly bothersome and others which may significantly affect quality of life. For example, involuntary loss of flatus (gas) may not be as bothersome as involuntary loss of liquid or solid stool.  However, for women experiencing involuntary loss of fecal matter (either solid or liquid) one or more times weekly, this may be bothersome enough to curtail activities in order to avoid potentially embarrassing situations.  In other words, these women may avoid going socializing and going out in public.

 There are many risk factors for fecal incontinence, several of which are common to urinary incontinence.  Risk for developing fecal incontinence may be increased by vaginal delivery, particularly of a large baby or with a large tear into the rectum at the time of delivery, colorectal cancer, severe hemorrhoids, fissures, obesity, increasing age, and neurologic disorders.  Prevention and treatment at this time are largely aimed at increasing strength and blood flow to the pelvic muscles with pelvic floor physical therapy.  Many women respond to pelvic floor physical therapy and muscle training.  The best results are usually obtained by working with a trained pelvic floor physical therapist. 

 Surgical repairs may be tried and may be helpful in some circumstances, but there must be a thorough evaluation of the cause as well as an understanding that anatomic repair may not adequately improve function.  Consultation with a physician specializing in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology) may be helpful in determining whether a surgical repair is indicated. 

 When other conservative treatments are not effective, there is a new therapy available in the United States which has been used for this problem in Europe for several years.  Neuromodulation, or stimulation of specific nerves with a device similar to a pacemaker, may be helpful in treating this problem.  Treatment for urinary frequency, urgency and urge incontinence with neuromodulation has been available in the United States for several years.  However, the same treatment has recently been approved to treat fecal incontinence here as well.  Interstim (Medtronic) is an implantable, pacemaker-type device which delivers a constant, specific electrical stimulation to the nerves coming to the rectum and bladder.  Again, consultation with a Urogynecologist is helpful in determining whether a trial of this treatment may be indicated. 

 Call our offices to set up an appointment with a Urogynecologist if you’re experiencing fecal incontinence.  Don’t suffer silently.

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